1/22. Successful resuscitation of a verapamil-intoxicated patient with percutaneous cardiopulmonary bypass.OBJECTIVE: To describe our experience with the use of percutaneous cardiopulmonary bypass as a therapy for cardiac arrest in an adult patient intoxicated with verapamil. DESIGN: Case report. SETTING: Emergency department of a university hospital. PATIENT: A patient with cardiac arrest after severe verapamil intoxication. INTERVENTIONS: Percutaneous cardiopulmonary bypass and theophylline therapy. CASE REPORT: A 41-yr-old white male had taken 4800-6400 mg of verapamil in a suicide attempt. On arrival of the ambulance physician, the patient was conscious with weak palpable pulses and was transported to a nearby hospital. The patient developed a pulseless electrical activity, and cardiopulmonary resuscitation was started. Despite all advanced life support efforts, the patient remained in cardiac arrest. Therefore, he was transferred under ongoing cardiopulmonary resuscitation to our department, where percutaneous cardiopulmonary bypass was initiated immediately (2.5 hrs after cardiac arrest). The first verapamil serum concentration obtained at admittance to our institution was 630 ng/mL. After several ineffective intravenous epinephrine applications, the administration of 0.48 g of theophylline as an intravenous bolus 6 hrs and 18 mins after cardiac arrest led to the return of spontaneous circulation. The patient remained stable and was transferred to an intensive care unit the same day. He woke up on the 12th day and was extubated on the 18th day. After transfer to a neuropsychiatric rehabilitation hospital, he recovered totally. CONCLUSION: In patients with cardiac arrest attributable to massive verapamil overdose, percutaneous extracorporeal cardiopulmonary bypass can provide adequate tissue perfusion and sufficient cerebral oxygen supply until the drug level is reduced and restoration of spontaneous circulation can be achieved.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/22. barium carbonate intoxication.A 22-year-old man attempted to commit suicide by swallowing an unknown amount of barium carbonate dissolved in hydrochloric acid. Shortly after ingestion, he developed crampy abdominal pain and generalized muscle weakness. About 2 h later, respiratory failure ensued necessitating orotracheal intubation and mechanical ventilation. Concomitantly, life-threatening arrhythmias including ventricular fibrillation occurred, and he had to be resuscitated for 45 min. After correction of severe hypokalemia (serum potassium 1.5 mmol/l), cardiac rhythm stabilized. In an attempt to accelerate removal of barium from the circulation hemodialysis was begun. During hemodialysis muscle strength returned. Pharmacokinetic analysis of serum barium levels suggest that hemodialysis shortened the serum half-life of barium. Subsequently, the patient made a complete and uneventful recovery. Our case demonstrates that severe barium poisoning can be survived provided that early aggressive therapeutic measures are undertaken. Hemodialysis seems to be efficacious in the therapy of barium intoxication.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
3/22. Acute mannitol intoxication in a patient with normal renal function.A young, previously healthy patient with multiple trauma mistakenly received 400 grams of mannitol over a 3-hour period. The laboratory report of hyponatremia prompted treatment with hypertonic saline before the hyperosmolar state was recognized. The osmolal gap was 118. mannitol intoxication in a patient without preexisting renal failure is unusual. Identification of an abnormal osmolal gap and recognition of the hyperosmolar state is discussed.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
4/22. Severe self-poisoning with oxetorone: report of one case.The authors report a case of severe self-poisoning with oxetorone. plasma concentration of the drug assessed by HPLC was a thousand times higher than therapeutic levels. coma, convulsions, and cardiac conduction defects were observed, similar to those noted with tricyclic and tetracyclic antidepressant poisoning. Similar cardiac disorders consisting of conduction defects had not been previously described during oxetorone intoxication.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
5/22. Treatment of severe imipramine poisoning complicated by a negative history of drug ingestion.The wide use of imipramine (Tofranil) for the treatment of nocturnal enuresis continues in spite of the unique dangers associated with this drug. Young children are particularly susceptible to the potentially lethal central nervous system and cardiovascular toxicities, yet the toxic potential of imipramine remains unrecognized by both parents and too many physicians. Management of severe imipramine intoxication can be difficult. This report describes a 12-month-old patient with severe imipramine intoxication whose treatment was complicated by a negative history at presentation.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
6/22. Ingestion of cannabis: a cause of coma in children.Previous reports of accidental ingestion of cannabis by children are rare. None has reported coma, although one described a stuporous state that required assisted ventilation. Over the past four years, the staff of british columbia's Children's Hospital has managed six children with cannabis toxicity, three of whom presented in coma, including one with airway obstruction. Recurring diagnostic features included rapid onset of drowsiness, moderate pupil dilation, hypotonia, lid lag, and the presence of small granules or leaves in the mouth. Confirmation was obtained by positive urine screening for cannabinoids. The six cases described emphasize the need for emergency physician awareness of possible diagnostic criteria, the potential severity of intoxication, and the need for prevention through parent education.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
7/22. Accidental cocaine intoxication in a nine-month-old infant: presentation and treatment.A case of a nine-month-old male who ingested cocaine is presented. The rarity of this type of ingestion, as well as the caretaker's denial of the presence of cocaine in the household, made rapid diagnosis of this infant's malady difficult. We present this case to alert physicians to the presentation and treatment of cocaine-intoxicated infants.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
8/22. Hyperbaric oxygen for methylene chloride poisoning: report on two cases.Two cases of methylene chloride poisoning treated with hyperbaric oxygen are presented and discussed. Both patients were found unconscious in an occupational setting. carboxyhemoglobin level determination and neuropsychological evaluation confirmed a diagnosis of carbon monoxide intoxication subsequent to methylene chloride exposure. The serial carboxyhemoglobin levels and carbon monoxide Neuropsychological Screening Battery scores obtained from these patients suggest that toxicity from methylene chloride-derived carbon monoxide responds well to treatment with hyperbaric oxygen.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
9/22. Unexpected cocaine intoxication presenting as seizures in children.We report four cases of unexpected cocaine intoxication in children manifested by the sudden development of seizures. Each patient presented with seizure activity of unknown etiology. toxicology screens were positive for cocaine and its metabolites. All four had normal head computed tomography scans and have not required long-term use of anticonvulsants. One infant developed a mild learning disability. cocaine intoxication should be considered in the differential diagnosis of new onset seizure activity in children. child protection agencies should be consulted in all cases due to a high probability of abuse or neglect.- - - - - - - - - - ranking = 6keywords = intoxication (Clic here for more details about this article) |
10/22. beer potomania syndrome in an alcoholic.To summarize, patients with the "beer potomania" syndrome are characterized by 1) a history of chronic alcohol ingestion (in a hypotonic form); 2) protein malnutrition; 3) signs, symptoms and laboratory values consistent with water intoxication, including hyponatraemia, hypochloraemia and, usually, hypokalaemia; 4) no evidence of another cause of hyponatraemia such as steroid use, diuretic use, hyperlipidaemia, etc. The pathophysiology involves the inability to excrete sufficient free water, based on a loss of normal renal urea gradients. patients may actually be total-body sodium depleted, yet have elevated urinary sodium and fractional sodium excretion due to this disorder of water metabolism. attention to proper nutrition during the acute illness may obviate the need for potentially hazardous administration of hypertonic saline.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
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